Non-sterile Gloves Research Articles

P14.19 Contamination of non-sterile gloves by Bacillus cereus and non-spore forming bacteria

P14.19 Contamination of non-sterile gloves by Bacillus cereus and non-spore forming bacteria

Aspergillose cutanée secondairement invasive chez un nouveau-né prématurissime : cas clinique et revue de la littérature

Aspergillus is a ubiquitous fungus that can cause primary cutaneous aspergillosis in extremely low-birth-weight (ELBW) neonates, then be invasive and lead to death. ELBW neonates are particularly at risk because of decreased qualitative immune defenses and defects in the skin barrier. Broad-spectrum antimicrobial therapy and corticosteroids, often used in these patients, contribute to increased risk. We present a fatal case of primary cutaneous aspergillosis complicated with invasive aspergillosis, confirmed by autopsy, in an ELBW infant. The source of contamination was probably non-sterile disposable latex gloves used for neonatal care. The early recognition of this source led to its eviction for other hospitalized ELBW infants and no outbreak was observed.

Standard precautions: knowledge and practice among nursing and medical students in a teaching hospital in Brazil

Compliance with standard precautions measures is essential to prevent and control healthcare-associated infections. The objective of the study was to evaluate the knowledge and practice of hand washing, use of gloves and the handling and disposal of needlesticks and other sharp objects among nursing and medical students. This is a descriptive observational study, which used a questionnaire and a check list. Knowledge of standard precaution measures was evaluated in 48/48 (100.0%) nursing students and 93/112 (83.0%) medical students. At the teaching hospital, 26/37 (70.3%) nursing students and 78/93 (83.9%) medical students belonging to the population being investigated were observed during their clinical practice. These results were compared intra groups. Knowledge of hand hygiene procedures was higher than what was observed in the clinical practice in both groups of students, (X²; p≤0.001). Compliance with the use of sterile and non-sterile gloves, and handling and disposal of needlesticks and other sharp objects was higher than the knowledge of these procedures among nursing students, and a statistically significant difference was observed with regards to sterile glove usage (X²; p=0.009). Regarding medical students, there was no statistical difference between knowledge and practice insofar as these two types of gloves were concerned, as well as regarding the handling and disposal of needlesticks and other sharp objects. Performance of both groups in terms of knowledge of hand hygiene showed a dichotomy between the teaching and the practice of these standard precautions. Results have shown a deficiency in the teaching-learning process for the other measures evaluated.

How Do Infection Control Practices in Mohs Surgery Affect the Infection Rate

Rates of infection after Mohs surgery and the associated reconstruction range from 0.72% to 4.25%. In two recent trials, researchers evaluated the effectiveness of infection-control practices and clean surgical techniques for preventing infection. In a retrospective study, Martin and colleagues compared infection rates before and after a change in infection prevention and control practices at a single-surgeon academic Mohs practice. Before the change, staff washed hands between stages; wore scrubs, masks, and nonsterile gloves for the Mohs surgery; and wore sterile gloves and drapes for the reconstruction. …

Sterilization requirements for miniscrew placement

Sterilization requirements for miniscrew placement

Évaluation des pratiques d’hygiène en anesthésie entre 1998 et 2007 en Lorraine

To study the assessment of hygiene practices in anaesthesia in Lorraine between 1998 and 2007, after recommendations from the French Society of Anaesthesia and Reanimation (SFAR) in December 1997, and different local actions. Two surveys performed at a nine-year interval in Lorraine hospitals. Questionnaires about risk infection management and hygiene practices were sent by post to all anaesthetists, nurse anaesthetists and recovery room nurses in 1998 (n=279) and in 2007 (n=259). Between the two surveys multidrug-resistant bacteria signalling, movements of the staff in operating rooms, septic isolation protocol and management of single-use disposable anaesthesia material have been improved (p<0.05). Central venous catheters are less performed in recovery rooms and rings wearing decreased by 16% (p<0.05). Wearing of nonsterile gloves for peripheral venous catheter and intubation is not generalized (p<0.05). About half of the hospitals have cleanup procedures of anaesthesia furniture. Washing of hands by anaesthesia staff is not sometimes respected but it's more frequent for medicine preparation and between two operations. A good skin disinfection (cleaning - rinsing - drying - antiseptic) is more recurrent in 2007 (61.4%) than in 1998 (41.9%) for arterial catheter. Wearing of glasses for intubation is each times rare, about 15%. Hygiene practices in anaesthesia in Lorraine have been improved between the two surveys by recommendations from the Sfar and the work of the Antenne Régional de Lorraine (audits, manuals, formations). Promising progress has been made but some points must still be worked on.

Successful control of a hospital-wide vancomycin-resistant Enterococcus faecium outbreak in France

We describe the control of a hospital-wide vancomycin-resistant Enterococcus faecium (VRE) outbreak in a 2,000-bed university hospital located on three different sites in Clermont-Ferrand, France. From January 2004 to April 2007, 220 VRE cases were identified. Overall, 28 different wards had at least one case. All of the strains expressed a high level of resistance to vancomycin and to teicoplanin carried by the vanA gene. Pulsed-field gel electrophoresis (PFGE) analysis of the strains revealed that they were clonally related. Control measures consisted of implementing a strategy of VRE screening by rectal swab, reinforcing hand hygiene practices and taking contact precautions. Recommendations for a restricted use of specific antibiotics were sent to each physician. Alcohol-based handrubs were provided throughout the hospital and the staff underwent training for their use. Compliance with contact precautions, including the use of clean non-sterile gloves and single-use gowns, was reinforced. VRE cases were assigned systematically to a single-bed room. In October 2007, no new VRE carriage has been detected for 7 months and no clinical samples had been VRE-positive for 10 months. In conclusion, a hospital-wide VRE outbreak was successfully controlled by a strategy based on routine screening, the reinforcement of hand hygiene and taking barrier precautions.

Synthetic Latex Conduits as an Aid for Microsurgical Training

Sir: We read with interest the article on a novel technique to aid microsurgical training.1 We would like to compliment the authors on the method they describe. The cornerstone of microsurgical training involves anastomoses in live models in a laboratory or clinical setting. Stringent ethical issues and increasing expenses in running animal laboratories make access difficult for regular and sustained training.2 The development of alternative models that allow for realistic and effective practice is of increasing importance. We propose a simple innovation that has negligible cost, is readily accessible, and has been used successfully in our unit to enable the instruction of trainees in anastomotic techniques using the microscope. To obtain as realistic a “vessel” as possible, we cut the rolled rim/sleeve of nonsterile latex gloves. Transecting these at different levels reveals a hollow conduit of variable diameter and wall thickness (Fig. 1). The pliable nature and thin wall of the latex in such gloves allows for the accurate simulation of authentic vessels with the realistic passage of suture material ranging from 8-0 to 11-0 nylon (Fig. 2). After completion of the anastomosis, the ends can be opened perpendicular to the suture line and the sutures inspected individually for accuracy of placement.Fig. 1.: Hollow conduit of variable diameter and wall thickness.Fig. 2.: Accurate simulation of authentic vessels with realistic passage of sutures ranging from 8-0 to 11-0 nylon.The use of latex glove material in microsurgical training has previously been described.3 The technique that we propose has the advantage of increased authenticity and accessibility in that an intact “tube” is readily available without the need for further fabrication as described in the article by Kamath and Kamath.1 Gloves with rolled sleeve ends are used in most hospitals, do not require any further special preparation, and are of low cost. We hope that our idea proves useful to both trainees and trainers in practicing or teaching anastomotic technique on a regular basis. Shakeel Dustagheer, M.R.C.S. Alastair P. Brown, F.R.C.S.(Plast.) Northern Ireland Plastic and Maxillofacial Service Ulster Hospital Belfast, Ireland

Minor surgery in general practice: are sterilised gloves necessary?

The use of non-sterile gloves during minor surgery is normal care in general practice. The Dutch College of General Practitioners has issued a guideline for infection prevention based on the regulation of the Dutch Working Party on Infection Prevention.1 Under the section ‘Minor surgery’ it is stated: ‘When a wound is closed with a suture, one has to work under sterile conditions. This means: sterile gloves, sterile working area and sterile material.’ There is no evidence in the guideline to …

Clean versus sterile technique for common joint injections: a review from the physiatry perspective

Preparation of the skin prior to joint injection varies widely among disciplines and across regional borders. This is likely due to the paucity of literature on the most effective and efficient methods of preparation. There is no standard definition of clean technique prior to joint injection. Review of the available literature suggests that alcohol is effective preparation for the skin prior to most procedures. Surveys of current clinical practice demonstrate that the use of gloves may be favored, but no conclusions can be drawn in regards to whether sterile gloves are required. Clean technique should be defined as use of non-sterile gloves and agents such as alcohol or soap prior to injection. Significant cost savings may be achieved with the consistent use of clean technique for preparation of the skin prior to joint injection. Further study should address the incidence of iatrogenic bacterial arthritis following clean technique versus sterile technique for joint injection.

Comparative Analysis of 2 Techniques of Double-Gloving Protection During Arch Bar Placement for Intermaxillary Fixation

This study was conducted to comparatively evaluate, in a prospective and randomized manner, 2 techniques for providing double-gloving protection during arch bar placement for intermaxillary fixation. A total of 42 consecutive patients in whom application of an Erich bar was indicated for intermaxillary fixation were equally divided into 2 groups. In group 1, 2 sterile surgical gloves were used; in group 2, a nonsterile disposable inner glove was used under a sterile surgical glove. Wilcoxon, Mann-Whitney, Kruskal-Wallis, and binomial statistical tests were used to analyze the findings. A total of 103 perforations were found in the outer gloves (47 in group 1 and 56 in group 2), along with 5 perforations in inner gloves in both groups (alpha = .01). No significant statistical difference was found between groups in terms of inner glove perforations (alpha = .05). The nondominant hand presented with 70.9% of the perforations, statistically significant to 1%. Both double-gloving techniques were found to provide effective clinician protection. The use of a nonsterile disposable glove under the surgical glove is possible for less-invasive procedures, offering the same safety as using 2 sterile surgical gloves while decreasing operational costs. This method does not eliminate the need to change gloves when a perforation is suspected or noted during the surgery, however.

Effect of two work practice changes on the microbial contamination rates of pharmacy-compounded sterile preparations

Using a multiple-step testing medium-risk-level compounding test procedure, the evaluation of two work-practice changes to determine if the changes could effectively reduce the potential for contamination occurrence was conducted. Along with training and evaluation of aseptic sterile compounding techniques, each individual pharmacist and pharmacy technician at M. D. Anderson Cancer Center must successfully demonstrate aseptic preparation competency annually by performing the complicated multistep aseptic transfers of growth medium with no resulting growth of microorganisms. The multistep aseptic transfers are designed to simulate manual compounding of the most complicated medium-risk-level preparations anticipated as specified in the United States Pharmacopeia's chapter 797. An evaluation of two modest and simple work-practice changes was conducted: The use of bare hands and nonsterile gloves with only initial disinfection with 70% isopropyl alcohol (IPA) during years 1 and 2 (group A) was compared with the use of nonsterile chemotherapy gloves with initial and repeated disinfection with IPA for year 3 (group B) and the use of sterile gloves with initial and repeated disinfection with IPA for year 4 (group C). The process involved multiple discrete manipulations, including reconstitution of dry-growth medium; transfers of growth medium from vials and ampules using syringes, needles, a dispensing pin, and a filter straw; and transfers to an empty plastic i.v. bag. For groups B and C, significant reductions in contaminated samples were found compared with group A. The use of protective chemotherapy gloves that were repeatedly disinfected with IPA decreased the contamination rate of pharmacy-compounded sterile preparations.

Ultrasound Guidance for Peripheral Venous Access: A Simplified Seldinger Technique

Asheville Surgery Center, Asheville, North Carolina. stonemd@charter.netOccasionally, patients for ambulatory surgery present with difficult peripheral venous access. Because only short-term access is needed, I prefer to avoid central venous cannulation and the associated risks. In these cases, I have begun using ultrasound guidance and a simplified Seldinger1technique for upper extremity peripheral venous access. A description of the technique and the results of a series of 10 procedures follows.In this technique, a tourniquet is applied to the upper arm. Alcohol or povidone iodine is used to prepare the antecubital fossa and distal upper arm. Disposable, nonsterile gloves are worn, and draping is unnecessary. A 10-5 MHz ultrasound probe (Sonosite Titan, L38; Sonosite, Bothell, WA) is covered with gel, an occlusive dressing (3M Tegaderm 10 × 12 cm; 3M, St. Paul, MN), and then additional sterile gel. Using a transverse view, an appropriate, nonthrombosed vein is identified. This may be the cephalic, basilic, or brachial vein. The brachial artery and median nerve are identified, so they can be avoided. Lidocaine is infiltrated 1–2 cm distal to the planned insertion site. I then use a spring-wire guide/catheter over needle assembly, usually used for arterial catheterization (Arrow arterial catheterization set FA-0420; Arrow International, Reading, PA). It consists of a 10.8-cm, 20-gauge catheter over a 22-gauge thin wall needle with an integral 0.46-mm-diameter spring wire guide. Using a transverse or longitudinal view and a free hand technique, the needle is inserted into the selected vein under real-time imaging. When ultrasound imaging shows the needle in the vein and venous blood flashback appears, I ask an assistant to advance the spring wire guide. Alternately, I drop the ultrasound probe and advance the wire myself. Next, the catheter is advanced over the wire, the tourniquet is released, and the needle/wire assembly is removed.Table 1shows the results of a series of 10 consecutive ultrasound-guided peripheral venous access procedures performed by the author. Patients were included in this series if at least two attempts at standard peripheral venous access failed or no adequate sized veins were visible or palpable in the upper extremity. Success was defined by the ultrasound view of the catheter in the vein and free flow of venous-appearing blood from the catheter. Each separate skin puncture was considered an attempt. Time was defined as the interval from initial skin puncture until success was achieved or the procedure was aborted. Nine of 10 catheter insertions were successful. There was an average of 1.3 attempts per procedure. The time required for a procedure averaged 140 s.Ultrasound guidance is used commonly for peripherally inserted central catheters2and occasionally for standard peripheral venous access. In emergency medicine applications, Keyes et al. 3found that a 5-cm catheter over needle infiltrated 8% of the time, and therefore, a longer catheter might be useful for these deeper veins. Sandhu and Sidhu4recommended long needle-mounted catheters or a Seldinger technique for deep veins. Using a guide wire may help to ensure that an advancing catheter enters the vein properly. However, a standard Seldinger technique takes more time and requires sterile gloves, draping, and a table to hold the wire, tissue dilator, and catheter.Ultrasound guidance for peripheral venous access may be improved by the use of a simplified Seldinger technique. The Arrow catheter set is commonly used for arterial catheterization, so anesthesiologists should be familiar with its use. The series described here demonstrates that this technique has a good success rate and the procedure takes a relatively short time to complete. Ultrasound guidance using this catheter may prevent multiple puncture attempts and decrease the use of unnecessary central venous catheters.Asheville Surgery Center, Asheville, North Carolina. stonemd@charter.net

Sterile Versus Nonsterile Gloves During Mohs Micrographic Surgery: Infection Rate is not Affected

Sterile Versus Nonsterile Gloves During Mohs Micrographic Surgery: Infection Rate is not Affected

Precauciones en la atención de pacientes hospitalizados por influenza aviar H5N1

Several agencies have proposed infection control guidelines for management of patients admitted with the diagnosis of avian influenza. These guidelines aim to prevent transmission from the patient to hospital personnel and other inpatients. The guidelines presented here by the Advisory Committee of Nosocomial Infections have been elaborated for the local medical community after reviewing currently available recommendations. Key recommendations include admission to an isolation ward, cohorting of confirmed cases, hand hygiene with antiseptic solutions, use of N95 type masks, non-sterile disposable gloves and eye protection equipment during examination or when performing aerosols-generating procedures. Use of patient-exclusive clinical instruments, daily disinfection of the hospital ward, implementation of measures to reduce risk of needle stick injuries and eye splashing, and reinforcement of appropriate sampling and transport of blood and other corporal fluids, are also recommended.

Precautions in the care of patients hospitalized with H5N1 avian influenza

Several agencies have proposed infection control guidelines for management of patients admitted with the diagnosis of avian influenza. These guidelines aim to prevent transmission from the patient to hospital personnel and other inpatients. The guidelines presented here by the Advisory Committee of Nosocomial Infections have been elaborated for the local medical community after reviewing currently available recommendations. Key recommendations include admission to an isolation ward, cohorting of confirmed cases, hand hygiene with antiseptic solutions, use of N95 type masks, non-sterile disposable gloves and eye protection equipment during examination or when performing aerosols-generating procedures. Use of patient-exclusive clinical instruments, daily disinfection of the hospital ward, implementation of measures to reduce risk of needle stick injuries and eye splashing, and reinforcement of appropriate sampling and transport of blood and other corporal fluids, are also recommended.

Bacterial contamination of nonsterile disposable gloves before use

After Bacillus cereus recovery in opened boxes of disposable gloves, the bacteriological contamination of disposable nonsterile gloves kept stored in native packages was investigated prospectively. Thirty-six commercially available nonsterile nonpowdered disposable gloves made of latex, vinyl, or nitrile were cultured. A large variety of spore-forming and non-spore-forming bacteria was recovered, including Bacillus cereus and Clostridium perfringens. This finding must be taken into consideration for care involving gloves in very immunocompromised patients.

Sterile Versus Nonsterile Gloves During Mohs Micrographic Surgery: Infection Rate is not Affected

Mohs micrographic surgery (MMS) is an outpatient procedure that has become the treatment of choice for certain cutaneous malignancies. Although the major steps in this procedure are relatively standardized, one difference involves the use of sterile or nonsterile, clean gloves during the tumor removal phase. This retrospective chart review study was performed to evaluate whether infection rates are affected by the use of sterile versus nonsterile gloves in the tumor extirpation phase of MMS. This study evaluated the surgical records of 1,810 consecutive Mohs patients, of which 1,239 Mohs patients (1,400 Mohs procedures) met inclusion criteria. Age, sex, tumor diagnosis, anatomic location, number of Mohs stages, area of the defect, closure type, cartilage exposure, and sterile versus nonsterile glove use were recorded and evaluated. Twenty-five infections were identified. Statistically significant infection rates were discovered for patients with cartilage fenestration with secondary healing and malignant melanoma diagnosis only. There was no statistical difference in infection rates with all other measured variables to include the use of sterile or clean, nonsterile gloves. Our study lends support to the contention that clean, nonsterile gloves are safe and effective for use in the tumor extirpation phase of MMS, at a significant cost savings.

CHAPTER 4

CHAPTER 4

Sterile Versus Nonsterile Gloves During Mohs Micrographic Surgery

BACKGROUND Mohs micrographic surgery (MMS) is an outpatient procedure, which has become the treatment of choice for certain cutaneous malignancies. Although the major steps in this procedure are relatively standardized, one difference involves the use of sterile or nonsterile, clean gloves during the tumor removal phase. OBJECTIVE This retrospective, chart review study was performed to evaluate whether infection rates are affected by the use of sterile versus nonsterile gloves in the tumor extirpation phase of MMS. METHODS This study evaluated the surgical records of 1,810 consecutive Mohs patients, of which 1,239 Mohs patients (1,400 Mohs procedures) met inclusion criteria. Age, sex, tumor diagnosis, anatomic location, number of Mohs stages, area of defect, closure type, cartilage exposure, and sterile versus nonsterile glove use were recorded and evaluated. RESULTS Twenty-five infections were identified. Statistically significant infection rates were discovered for patients with cartilage fenestration with secondary healing and malignant melanoma diagnosis only. There was no statistical difference in infection rates with all other measured variables to include the use of sterile or clean, nonsterile gloves. CONCLUSION Our study lends support that clean, nonsterile gloves are safe and effective for use in the tumor extirpation phase of MMS, at a significant cost savings.